Active fluid de-resuscitation in critically ill patients with septic shock: A systematic review and meta-analysis
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Purpose To evaluate the impact of active fluid de-resuscitation on mortality in critically ill patients with septic shock. Methods A systematic search was performed on PubMed, EmBase, and the Cochrane Library databases. Trials investigating active fluid de-resuscitation and reporting data on mortality in patients with septic shock were eligible. The primary objective was the impact of active de-resuscitation in patients with septic shock on short-term mortality. Secondary outcomes were whether de-resuscitation lead to a fluid separation, and the impact of de-resuscitation on patient-centred outcomes. Results Thirteen trials (8,030 patients) were included in the systematic review, whereof 5 randomised-controlled trials (RCTs) were included in the meta-analysis. None of the RCTs showed a reduction in mortality with active de-resuscitation measures (relative risk (RR) 1.12 [95%-CI 0.84 - 1.48]). Fluid separation was achieved by two RCTs. Evidence from non-randomised trials suggests a mortality benefit with de-resuscitation strategies and indicates a trend towards a more negative fluid balance. Patient-centred outcomes were not influenced in the RCTs, and only one non-randomised trial revealed an impact on the duration of mechanical ventilation and renal replacement requirement (RRT). Conclusion We found no evidence for superiority of active fluid de-resuscitation compared to usual care regarding mortality, fluid balance or patient-centred outcomes in patients with septic shock.…
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Systematic reviews and meta-analyses found no evidence that fluid restriction or fluid de-resuscitation is superior to higher fluid volumes for mortality in septic shock.
“Systematic reviews and meta-analyses additionally found no evidence that fluid restriction or fluid de-resuscitation is superior to higher fluid volumes for mortality in septic shock, underscoring uncertainty about optimal cumulative fluid balance strategies [24,25,26].”
From Artificial Intelligence to Facilitate SEP-1 Measure Compliance and Fluid Management in Sepsis (2026) · cites this paper as [24]
Cites
A randomized trial of protocol-based care for early septic shock.
The ProCESS Investigators (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1401602 · Cited by 2,414 · see citing works
Malbrain, M. L. N. G., Van Regenmortel, N., Saugel, B., De Tavernier, B., Van Gaal, P.-J., Joannes-Boyau, O., Teboul, J.-L., Rice, T. W., Mythen, M., & Monnet, X. (2018) · Annals of Intensive Care · doi:10.1186/s13613-018-0402-x · Cited by 632 · see citing works
Conservative Fluid Management After Sepsis Resuscitation: A Pilot Randomized Trial
Semler, M. W., Janz, D. R., Casey, J. D., Self, W. H., & Rice, T. W. (2020) · Journal of Intensive Care Medicine · doi:10.1177/0885066618823183 · Cited by 38 · see citing works
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Artificial Intelligence to Facilitate SEP-1 Measure Compliance and Fluid Management in Sepsis
Nguyen, H. B., Krishtopaytis, E., Lopez, E., Farnoudi, N., Van, T., Kharalampova, V., & Coz Yataco, A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15093477
“Systematic reviews and meta-analyses additionally found no evidence that fluid restriction or fluid de-resuscitation is superior to higher fluid volumes for mortality in septic shock, underscoring uncertainty about optimal cumulative fluid balance strategies [24–26].”
- Authors
- Messmer, A. S., Dill, T., Müller, M., & Pfortmueller, C. A.
- Affiliations
- University of Bern (CH)
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2023-03
- Volume
- 109
- Pages
- 89-96
- ISSN
- 0953-6205 (ISSN-L)
- OpenAlex
- W4315498546
- Cited by
- 35
- References
- 3
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 9 · 2023: 4
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Internal Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
- Open Access CRIS of the University of Bern
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- septic shock, critically ill patients, mortality, fluid balance, fluid separation, patient-centered outcomes, mechanical ventilation duration, renal replacement therapy, fluid overload
- MeSH terms
- Fluid Therapy, Humans, Respiration, Artificial, Resuscitation, Shock, Septic, Critical Illness
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